年龄如何影响中风后一年的护理依赖风险？一项基于德国健康保险基金理赔数据的研究。
How does age affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund.
作者信息
Schnitzer Susanne, von dem Knesebeck Olaf, Kohler Martin, Peschke Dirk, Kuhlmey Adelheid, Schenk Liane
机构信息
Department of Medical Sociology and Rehabilitation Science, Charité-Universitätmedizin Berlin, Luisenstr. 57, D-10117, Berlin, Germany.
Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany.
出版信息
BMC Geriatr. 2015 Oct 23;15:135. doi: 10.1186/s12877-015-0130-0.
BACKGROUND
The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease?
METHODS
The study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis.
RESULTS
21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0-65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82-16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88-6.71) in patients aged 76-85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %).
CONCLUSIONS
Our results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age-dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed.
背景
本研究的目的是调查年龄对卒中后1年护理依赖风险的影响。研究涉及两个问题：（1）年龄与卒中后1年护理依赖风险之间的关联强度如何？（2）这种关联能否用疾病负担来解释？
方法
本研究基于德国法定健康保险基金的理赔数据。研究人群来自2007年所有主要诊断为缺血性卒中、出血性卒中或短暂性脑缺血发作且卒中后存活1年且首次卒中前不依赖护理的持续参保成员（n = 2864）。数据收集期为1年。如果因身体、精神或心理疾病或残疾，在至少6个月的时间里进行日常生活活动需要大量帮助，则被视为依赖护理。通过卒中亚型、卒中病史、合并症以及老年多病共存情况评估疾病负担。采用回归模型进行数据分析。
结果
在观察期内，21.6%的患者出现护理依赖。卒中后护理依赖风险与年龄显著相关。相对于参照组（0 - 65岁），86岁及以上患者护理依赖的比值比为11.30（95%置信区间：7.82 - 16.34），76 - 85岁患者为5.10（95%置信区间：3.88 - 6.71）。这些关联不能用疾病负担来解释。相反，当回归模型纳入疾病负担时，年龄效应变得更强（增加1.1%至28%）。
结论
我们的结果表明，年龄对护理依赖风险有影响，且不能用疾病负担来解释。因此，必然存在其他潜在的年龄依赖性因素来解释剩余的年龄效应（如社会状况）。需要进一步研究来探索所观察到的强烈年龄效应的原因。
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